What is an overactive bladder?
Overactive bladder (OAB), a highly specific type of urinary incontinence, is a common lower urinary tract dysfunction characterized by a sudden, uncontrollable urge to urinate. It can cause urinary incontinence during the day as well as bedwetting at night. Generally, families with children with overactive bladder problems ask their children whether they need to toilet constantly, but the feeling of sudden urination is a situation that the child often experiences despite having very little urine. Therefore, it is not a case of overfilling of the bladder, on the contrary, small amounts of urination as well as an increased frequency of peeing are quite typical in children with OAB. Very rarely, children with OAB can leak urine while sneezing or laughing. Children's constant bedwetting concerns and their desire to go to the toilet constantly affect their social and emotional development negatively. OAB also causes some bladder and kidney problems in children. The most common among them are; difficulties in emptying the entire bladder, an increased risk of kidney disorders, and an increased risk of urinary tract infections.
What are the causes of OAB?
While our bladder stores urine, the bladder muscles are relaxed and the pelvic floor muscles are active. When the bladder is filled with a certain amount of urine, our brain sends a signal to the bladder. The bladder muscles contract and push the urine out of the urethra. The pelvic floor muscles relax and we urinate.
OAB occurs when the muscles in the bladder are very active. In this case, the bladder muscles contract to pee before the bladder is fully filled. The child feels a sudden and urgent need to urinate. It pees in very small volumes.
Other causes of OAB, which can affect children of all ages, may include:
- Experiencing constipation problems
- frequent urinary tract infections
- anxiety disorder
- Drinking caffeinated or carbonated beverages
- Nerve damage
- Avoiding emptying the bladder completely while on the toilet
- underlying sleep apnea
In some children, there may be a delay in maturation and the problem of OAB may diminish or disappear with age. However, pelvic floor muscles whose function is impaired with OAB are not treated, and this may lead to different problems when the child reaches adulthood.
What are the symptoms of OAB?
The most common symptom of OAB in children is the urge to go to the toilet more often than usual. The frequency of going to the toilet normally during the day is about 4-7 times, but this number increases considerably in children with OAB. Although they make a fluid restriction in order not to go to the toilet, the frequency of going to the toilet exceeds 10 during the day.
OAB is a problem of the filling phase of the bladder. For this reason, the internal muscles that make up the bladder contract even if the bladder is not full, creating a feeling of needing the toilet in children. In some cases, families cannot directly understand that their children's toilet needs are coming. If your child is doing pee-holding maneuvers to suppress the sudden squeezing feeling during the day (crossing his legs, pressing the perineum with hands, squatting, locking by standing still, sitting on the floor that will put pressure on the perineum), he may be experiencing the symptoms of OAB.
Among other symptoms; Despite the urge to urinate, there are inability to urinate or urination in a very small volume, frequent urinary tract infections and peeing accidents during the day and at night.
What treatments are commonly used in OAB?
- Bladder training:
Bladder retraining means sticking to a urination schedule and trying to urinate with or without the urge to urinate. A well-taught and successfully implemented bladder training is used as a first-line treatment approach in OAB. Thanks to this training Thanks to this training, the child's bladder is retrained by habit changes made in his daily life. Therefore, it is beneficial that this training is given by an experienced and constantly monitored pediatric urologist and pelvic floor physiotherapist.
- Biofeedback training:
Biofeedback was used for the first time in urology in patients with overactive bladder complaints. Today, it can be used in all bladder problems such as dysfunctional voiding, bladder wall muscle - bladder neck muscle incompatibility disorders, overactive bladder, underactive bladder.
The aim is to ensure that the pelvic floor muscles, which have an important place in voiding control, are used correctly and effectively. The tension, fatigue and endurance of the pelvic floor muscle should be evaluated before and after the treatment and the course of the treatment should be determined accordingly.
Biofeedback therapy alone is not enough to train the pelvic floor muscles. In addition to biofeedback therapy for an effective pelvic floor rehabilitation; Different physical therapy modalities such as different exercise approaches, manual therapy, breathing and posture training, and relaxation training should be added to the treatment. This rehabilitation should be done by a pelvic floor physiotherapist under the control of a pediatric urologist.
- Medication:
A detailed evaluation should be made before starting drug therapy. If there is a problem of constipation or urinary tract infection accompanying AAm, first of all, medication should be prescribed for these complaints.
The drugs used in OAB are intended to relax the overactive inner bladder muscle. Thus, excessive activity of the inner bladder muscles is prevented and the desire and frequency of going to the toilet is minimized. Before deciding on the use of such drugs, a detailed examination and clinical decision-making experience by the pediatric urologist is required. Some drugs may show side effects such as constipation and dry mouth. If the drugs are used without pelvic plate muscle rehabilitation, their efficacy is low, and the possibility of the complaints to come back when the intake is stopped is quite high. For this reason, families often realize that everything is back to normal when they stop taking the drug. Studies have emphasized that long-term treatment in OAB can only be with exercises for the pelvic floor muscles.
- Daily life changes:
A number of changes in daily life in bladder problems constitute an important part of the treatment. Some daily life changes that can be made:
Make sure your child avoids caffeinated drinks and foods. Caffeine is a bladder irritant that irritates the bladder.
To ensure the consumption of foods and beverages that are good for the bladder. These foods include pumpkin seeds, cranberry juice, and water.
- Neuromodulation (Electrical Stimulation with Superficial Electrodes)
Although the mechanism of nerve stimulation is still not fully understood, it is accepted that stimulation of the sacral nerve roots provides modulation of the reflex pathways between the pelvic floor, bladder and bladder outlet. Nerve stimulation therapy in the clinic; It is applied to the sacral region and the area around the ankle where the nerves related to the bladder pass. It is done using a TENS device. This is not a surgical procedure. It can be applied very easily with adhesive electrodes in the form of stickers. There are no side effects.
How do we, as Tuğtepe Children's Bladder and Bowel Disorders Center, treat OAB?
First of all, we take a detailed history as in every group of patients who apply to the clinic. Then, pelvic floor muscle evaluation is performed by our physiotherapists and we draw up a treatment plan according to the physical condition of the muscles. In our first session performed by physiotherapists, we provide detailed healthy bladder-bowel training (urotherapy). Our training includes a wide range of information ranging from eating habits, water consumption to toilet posture training. We highly value this first training session conducted by clinical physiotherapists and we want the information to be applied by the child and family. Thus, we aim to achieve maximum efficiency in the pelvic floor rehabilitation sessions. Then we start our pelvic floor rehabilitation sessions conducted by physiotherapists. Practices in the sessions include breathing exercises, manual therapy approaches, clinical exercises, electrotherapy applications and biofeedback training, and we change the intensities of the applications according to the course of the sessions. Our treatment algorithms are specific to each child and we enrich them according to the needs of the child, thus increasing our treatment success. Our primary goal in the treatments we apply is to restore the functioning of the pelvic floor muscles, whose function is impaired as a result of the child with OAB constantly trying to hold his pee. Thus, as a result of pelvic floor muscle exercises performed in children with OAB, we prevent frequent urination, sudden squeezing and small-volume urination. With the treatment we have done, we support our children to have a healthy bladder like their peers by increasing the bladder capacity and calming the overactive bladder muscles.